Post-Traumatic Stress Disorder and the Family

The symptoms of post-traumatic stress disorder (PTSD) and other trauma reactions change how a trauma survivor feels and acts. Therefore, traumatic experiences that happen to one member of a family can affect everyone else in the family. When trauma reactions are severe and go on for some time without treatment, they can cause major problems in a family.

It's no wonder that family members react to their loved one having experienced a trauma. It's upsetting when someone you care about goes through a terrible ordeal. And it's no wonder that people react to the way a traumatized family member feels and acts. Trauma symptoms can make a family member hard to get along with or cause him or her to withdraw from the rest of the family. It can be difficult for everyone when these changes occur. Just as people have different reactions to traumatic experiences, families also react differently when a loved one is traumatized.

Sympathy

One of the first reactions many family members have is sympathy for their loved one. People feel sorry that someone they care about has suffered. And they feel sorry when the person continues to suffer from symptoms of post-traumatic stress disorder and other trauma responses. It can be helpful for the person who has experienced the trauma to know that his or her family members sympathize with him or her, especially just after the traumatic event occurs.

Sympathy from family members, however, can have a negative effect. When family members' sympathy leads them to "baby" a trauma survivor and have low expectations of the survivor, it may send a message that the family doesn't believe the trauma survivor is strong enough to overcome the ordeal. For example, if a wife has so much sympathy for her husband that she doesn't expect him to work after a traumatic experience, the husband may think that she doesn't have any confidence in his ability to recover and go back to work.

Depression

One source of depression for family members can be the traumatic event itself. All traumas involve events where people suddenly find themselves in danger. When this happens in a situation or place where people are accustomed to feeling safe, just knowing the event happened could cause a person to lose faith in the safety and predictability of life. For example, if a woman gets mugged in the parking lot of a neighborhood shopping center, her family may find they feel depressed by the idea that they are not really as safe as they thought they were -- even in their own neighborhood.

It can also be depressing when a traumatic event threatens a person's ideals about the world. For instance, if a man gets traumatized in combat by seeing someone tortured, it can be depressing to know that people are capable of doing such cruel things to each other. Before the man experienced that event, he may have believed that people are basically good and kind.

Depression also is common among family members when the traumatized person acts in a way that causes feelings of pain or loss. There may be changes in family life when a member has post-traumatic stress disorder or other symptoms after trauma. The traumatized person may feel too anxious to go out on family outings. The traumatized person may not be able to work because of post-traumatic stress disorder symptoms. As a result, the family income may decrease and the family may be unable to buy things and do things they did before the traumatic event. A husband may feel unloved or abandoned when -- because of her depression -- his traumatized wife withdraws emotionally and avoids being intimate or sexual. Children whose father can't be in crowds because of combat trauma may feel hurt that their father won't come to see them play sports. When post-traumatic stress disorder lasts for a long time, family members can begin to lose hope that their loved one or their family will ever get "back to normal."

Fear and Worry

Knowing that something terrible can happen "out of the blue" can make people fearful. This is especially true when a family member feels unsafe and reminds other family members about possible dangers. Often, trauma survivors feel "on edge" and become preoccupied with trying to stay safe. They may want to get a guard dog or put up security lights or have weapons in the house for protection. When one person in a family is worried about safety, it can make everyone else feel unsafe too. However, something that helps one person feel safe -- like a loaded weapon under the bed -- may make another person feel unsafe.

Family members also can experience fear when the trauma survivor is angry or aggressive. Trauma survivors can become angry and aggressive automatically if they feel they are in danger. Trauma survivors also can become angry and aggressive because they are frustrated that they have trauma symptoms, or because they learned to be aggressive as a way to protect themselves in the trauma situation. No matter what the reason for the anger and aggression, it naturally makes family members fearful.

Many trauma symptoms can cause family members to worry. A wife might worry that her traumatized husband who becomes angry and violent at the least provocation will be injured in a fight or get in trouble with the police. A daughter may worry that her mother will make herself ill by drinking heavily as a result of a traumatic event. A man's inability to keep a job because of trauma-related problems may cause his family to worry constantly about money and the future.

Avoidance

Just as trauma survivors can be afraid to address what happened to them, family members frequently are fearful of examining the traumatic event as well. Family members may want to avoid talking about the trauma or trauma-related problems, even with friends. People who have experienced trauma hope that if they don't talk about the problem, it will go away. People also don't wish to talk about the trauma with others, because they are afraid that others won't understand or will judge them. Sometimes, if the traumatic event is associated with shame (such as rape) family members may avoid talking about it and its effects because of social "rules" that tell us it is inappropriate to talk about such things. Family members may also not discuss the trauma with others because they fear it will bring their loved one more shame.

Family members may avoid the things that the trauma survivor avoids because they want to spare the survivor further pain, or because they are afraid of his or her reaction. For example, the wife of a combat veteran who is anxious about going out in public may not make plans for family outings or vacations because she is afraid to upset her husband. Though she doesn't know what she can do to "fix" the problem, she does know that if the family goes to a public event, the husband will be anxious and irritable the whole time.

Guilt and Shame

Family members can feel guilt or shame after a traumatic event for a number of reasons. A family member may experience these feelings if he or she feels responsible for the trauma. For instance, a husband whose wife is assaulted may feel guilt or shame because he was unable to protect her from the attack. A wife may feel responsible for her husband's car accident if she thinks she could have prevented it if she had gotten the car's brakes fixed. A family member may feel guilt and shame if he or she feels responsible for the trauma survivor's happiness or general well-being, but sees no improvement no matter how hard he or she tries to help. Sometimes, after years of trauma-related problems in a family, a family member may learn about PTSD and realize that this is the source of their family problems. The family member may then feel guilty that he or she was unsupportive during the years.

Anger

Anger is a common problem in families that have survived a trauma. Family members may feel angry about the trauma and its effect on their lives. They may be angry at whomever they believe is responsible for the traumatic event (including God). They also can feel anger toward the trauma survivor. Family members may feel that the survivor should just "forget about it" and get on with life. They may be angry when their loved one continues to "dwell" on the trauma. A wife may be mad because her husband cannot keep a job or because he drinks too much, won't go with her to social events, avoids being intimate with her, or doesn't take care of the children. Family members also may feel angry and irritable in response to the anger and irritability the trauma survivor directs at them.

Negative Feelings

Sometimes family members have surprisingly negative feelings about the traumatized family member. They may believe the trauma survivor no longer exhibits the qualities that they loved and admired. A person who was outgoing before a trauma may become withdrawn. A person who was fun-loving and easy-going before a trauma may become ill-tempered. It may be hard to feel good toward a person who seems to have changed in many ways. 

Family members may also respond negatively to behaviors that develop following a trauma. For instance, family members may be disgusted by a woman's over-drinking in response to a trauma. Family members also may have negative feelings about the survivor that are directly related to the traumatic event. For example, a wife may no longer respect her husband if she feels he didn't behave bravely during a traumatic event. A husband whose wife was raped may feel disgusted about what happened and wonder if she could have done something to prevent the assault. A son may feel ashamed that his father didn't fight back when he was beaten during a robbery. Sometimes people have these negative feelings even when they know that their assessment of the situation is unfair.

Drug and Alcohol Abuse

Drug and alcohol abuse can become a problem for the families of trauma survivors. Family members may try to escape from bad feelings by using drugs or alcohol. A child or spouse may spend time drinking with friends to avoid having to go home and face an angry parent or spouse. On the other hand, spouses sometimes abuse drugs or alcohol to keep their loved ones "company" when they're drinking or using drugs to avoid trauma-related feelings.

Sleep Problems

Sleep can become a problem for family members, especially when it is a problem for the trauma survivor. When the trauma survivor stays up late to avoid going to sleep, can't get to sleep, tosses and turns, or has nightmares, it is difficult for family members to sleep well. Often family members also are unable to sleep well because they are depressed or they are worried about the survivor.

Health Problems

Family members of trauma survivors can develop health problems for a number of reasons. Bad habits (drinking, smoking, not exercising) may worsen as a result of coping with a loved one's trauma responses. In addition, many illnesses can be caused by trauma-related stress if it goes on for an extended period of time. When family members constantly feel anxious, worried, angry or depressed, they are more likely to develop stomach problems, bowel problems, headaches, muscle pain and other health problems.

Getting Help

What can families do to care for themselves and the survivor? Trauma survivors and their families often don't know what to do. First, it is important to continue to learn more about trauma and its effects. Treatment for post-traumatic stress disorder is available in most communities through psychologists and social workers in private practice. Insurance may help pay for this treatment. Community mental-health centers and private mental-health clinics (such as those run by charitable or church organizations) also may provide treatment, sometimes at low or reduced fees.

Veterans can receive treatment at a local VA Medical Center or VA Readjustment Counseling Service. Insurance may help pay for treatment at a VA center, and treatment for some veterans is provided at no cost (when their post-traumatic stress disorder is determined to be service-related).

Family members of a traumatized person should find out as much as they can about post-traumatic stress disorder and get help for themselves, even if their loved one doesn't seek treatment. Family members can encourage the survivor to inquire about education and counseling, but they should not pressure or try to force their loved one to get help. Classes or treatment may be useful for stress and anger management, addiction, couples communication, or parenting.

While in the process of getting help, if family members feel comfortable, they should let their loved one know that they are willing to listen if the survivor would like to talk about his or her trauma. But the family should stop if anyone gets too upset or overwhelmed. If everyone is able, it is also important to talk about how the trauma is affecting the family and what can be done about it.

Books to Read

Coping with Trauma: A Guide to Self-Understanding. J.G. Allen. American Psychiatric Press. Washington, D.C. 1995.

Recovering from the War: A Woman's Guide to Helping Your Vietnam Vet, Your Family and Yourself. P. Mason. 1990.

Vietnam Wives: Facing the Challenges of Life with Veterans Suffering Post Traumatic Stress. A. Matsakis. Sidran Press. ISBN 1-886968-00-4. 1996.

If you or someone you know is suffering from the signs of post-traumatic stress disorder, call for help.